The Power of Prevention Chronic disease . the public health challenge of the 21st century 2009 National Center for Chronic Disease Prevention and Health Promotion THE POWER OF PREVENTION CHRONIC DISEASE . THE PUBLIC HEALTH CHALLENGE OF THE 21ST CENTURY The United States spends significantly more on health care than any other nation. In 2006, our health care expenditure was over $7,000 per person, more than twice the average of 29 other developed countries.2 We also have one of the fastest growth rates in health spending, tripling our expenditures since 1990. Yet the average life expectancy in the United States is far below many other nations that spend less on health care each year. As a nation, more than 75% of our health care spending is on people with chronic conditions.3 These persistent conditions—the nation’s leading causes of death and disability—leave in their wake deaths that could have been prevented, lifelong disability, compromised quality of life, and burgeoning health care costs. The facts are arresting: • 7 out of 10 deaths among Americans each year are from chronic diseases.4 • In 2005, 133 million Americans—almost 1 out of every 2 adults—had at least one chronic illness.5 • About one-fourth of people with chronic conditions have one or more daily activity limitations.3 • Health disparities in chronic disease incidence and mortality are widespread among members of racial and ethnic minority populations. For example, heart disease death rates are higher among African Americans than whites,4 and diabetes rates are substantially higher among American Indians and Alaska Natives than whites.6 • Mental illnesses and chronic diseases are closely related. Chronic diseases can exacerbate symptoms of depression, and depressive disorders can themselves lead to chronic diseases.7 The scope and severity of the chronic disease problem has not escaped the public’s attention. More than two-thirds of all adults believe that the U.S. health care system should place more emphasis on chronic disease preventive care, and more than 4 in 5 Americans (84%) favor public funding for such prevention programs.8 WHAT ARE THESE CHRONIC CONDITIONS? Tackling chronic disease requires a closer look at the major conditions that affect our nation— namely, heart disease and stroke, cancer, diabetes, arthritis, obesity, respiratory diseases, and oral conditions. Heart disease and stroke The good news is that since 1999, death rates for coronary heart disease and stroke have declined 20.8% and 24.4%, respectively.4 In addition, the percentage of adults with high cholesterol, a major risk factor for heart disease, has been cut by almost half since the early 1960s.6 YET . • Heart disease and stroke remain the first and third leading causes of death, accounting for more than 30% of all mortality,4 and are among the leading causes of disability.9 • 1 million Americans are disabled from strokes; many can no longer perform daily tasks, such as walking or bathing, without help.9 • In 2003, approximately 37% of adults reported having two or more of the major risk factors for heart disease and stroke (high blood pressure, high cholesterol, diabetes, current smoking, physical inactivity, and obesity).10 • Many disparities persist—for example, age-adjusted stroke death rates for 2005 were 31% higher for African Americans than for whites, and heart disease death rates were 23% higher.4 Cancer During the past two decades, tremendous progress has been made in developing and using effec- tive cancer prevention strategies, early detection interventions, and cancer treatments. Largely through public health efforts targeting screening, breast cancer deaths among women decreased by 2% per year from 1998 to 2005, and deaths from colorectal cancer decreased among both men and women by 4% per year from 1995 to 2005. YET . • Cancer continues to claim more than half a million lives each year and remains the nation’s second leading cause of death.4 • Cancer does not affect all races equally in the United States. African Americans are more likely to die of cancer than people of any other racial or ethnic group. • The total number of Americans living with a previous diagnosis of cancer, currently estimated at 11 million, is on the rise. The most commonly diagnosed cancers are prostate, female breast, lung and bronchus, and colorectal cancers.12 • Lung cancer remains the leading cause of cancer death in both men and women.12 More than 80% of lung cancers are due to smoking or exposure to secondhand smoke.3 2 Diabetes Tremendous progress has been made in managing diabetes and its complications. Because of public health efforts, higher percentages of people with diabetes are monitoring their blood sugar daily and receiving, through health professionals, annual foot exams, eye exams, and influenza and pneumococcal vaccinations. The incidence of treatment for diabetes-related end-stage renal disease declined 21% from 1997 to 2002, and the prevalence of visual impairment among people with diabetes decreased as well, from 24% in 1997 to 18% in 2005.* YET . • Nearly 24 million Americans have diabetes. An estimated 57 million American adults have prediabetes, placing them at increased risk for developing type 2 diabetes.4 • Diabetes is becoming more common every day. If current trends continue, 1 in 3 Americans born in 2000 will develop diabetes during their lifetime.15 • Diabetes continues to be the leading cause of kidney failure, nontraumatic lower-extremity amputations, and blindness among adults aged 20–74.4 • American Indian and Alaska Native adults are twice as likely as white adults to have diabetes.6 Arthritis Arthritis is the nation’s most common cause of disability, affecting 1 of every 5 adults.16 As the U.S. population ages, the number of adults with doctor-diagnosed arthritis is projected to increase from 46 million to 67 million by 2030, and 25 million of these individuals will have limited activity as a result.17 Considerable progress has been made in raising awareness and understanding of effective, evidence-based messages and interventions (such as physical activity) to decrease disability and increase quality of life among those with arthritis. YET . • Having arthritis presents special barriers to engaging in physical activity, which in turn impedes medical and self-management efforts for arthritis and other chronic conditions. • 19 million U.S. adults report being limited in their usual activities because of arthritis.16 • The disabling effects of arthritis are disproportionately prevalent in racial and ethnic minority populations. For example, compared with whites, a higher proportion of African Americans reported severe pain as well as activity and work limitations attributable to arthritis.18 * Source: CDC, unpublished analysis of 2002 and 2005 Behavioral Risk Factor Surveillance System data, 2008. 3 Obesity Obesity has emerged as a priority in chronic disease prevention and has been linked to increased risk for heart disease, high blood pressure, type 2 diabetes, arthritis-related disability, and some cancers. After a quarter-century of increasing rates, obesity prevalence among children and adults appears to be leveling.19, 20 YET . • 1 in every 3 adults is obese.19 • Almost 1 in 5 youth between the ages of 6 and 19 is obese (BMI ≥ 95th percentile of the CDC growth chart).20 • 61% of obese children aged 5–10 years have one or more risk factors for heart disease, and 27% have two or more.21 • Among 12- to 19-year-old boys, the prevalence of obesity is higher among adolescent non-Hispanic African Americans (19%) and Mexican Americans (22%) than among non- Hispanic whites (17%).20 Among girls in this age group, non-Hispanic African Americans have the highest prevalence of obesity (28%); the prevalence is 20% among Mexican Americans and 15% among non-Hispanic whites.20 Respiratory diseases Smoking is the primary risk factor for chronic respiratory diseases, such as emphysema and chronic bronchitis, both of which are major conditions of chronic obstructive pulmonary disease (COPD).3 COPD, as well as lung cancer, could become relatively uncommon in future generations if smoking rates were substan- tially reduced.13,22 YET . • COPD remains the third leading cause of smoking-related deaths, killing about 93,000 adults annually.23 • From 1980 to 2000, the nation’s COPD death rates increased from 20.1 to 56.7 per 100,000 women and from 73.0 to 82.6 per 100,000 men.24 • Almost 60% of children—or 22 million children aged 3 to 11 years old—are exposed to secondhand smoke, which slows lung growth and increases risk for acute respiratory diseases and for more severe asthma.25 4 Oral conditions Mouth and throat diseases—such as tooth decay, periodontal (gum) disease, and oral cancers—cause pain and disability for millions of Americans each year. The good news is that remarkable progress has been made in oral health over the past few decades. The baby boomer generation will be the first in which the majority will main- tain their natural teeth over their entire lifetime, having benefited from water fluoridation and fluoride toothpastes.26 In addition, the use of dental sealants over the past several decades has significantly improved the oral health of children. YET . • More than 90% of adults aged 20–64 have experienced tooth decay.27 • Tooth decay is one of the most common diseases of childhood—5 times as common as asthma, and 7 times as common as hay fever.26 • Approximately 1 in 3 children aged 6–8 has had at least one cavity or filling, and 2 in 3 adolescents aged 16–19 have experienced tooth decay.27 • Children and adolescents living in poverty suffer more tooth decay than their more affluent peers.26 They are less likely to receive preventive treatments like dental sealants, and their dental disease is more than twice as likely to go untreated.